Medical A-Z

Coronavirus – What Do We Know So Far?

March 5, 2020

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Coronavirus – What Do We Know So Far?

The latest epidemic outbreak in China has made headlines in the media worldwide. Coronavirus is being portrayed as a new, unknown, and extremely dangerous virus. However, the coronavirus is not at all new and, statistically speaking, not particularly deadly either.

What is new? The SARS-CoV-2 strain of the virus in humans. This is the type that is currently responsible for the COVID-19, a potentially lethal disease that is in the media these days.

The purpose of this article is to fill the information gap and bring you all the scientific facts that you should know about the coronavirus epidemic.

Overview

The family of coronaviruses has been known to researchers for a long time. The first strain was isolated back in 1937 when it was found to be responsible for infectious bronchitis in poultry and birds.

The name “coronavirus” comes from a Latin word for a crown or halo. This is because, when observed through a microscope, the virus resembles little crowns.

In humans, coronavirus was first detected in the 1960s. It was isolated from the mucus of patients suffering from a common cold. Today we know that at least two types of coronavirus (229E and OC43) cause a significant portion of common flu cases every year worldwide.

Currently, seven known strains of coronavirus can infect and be transmitted between humans, these are:

· 229E (alpha coronavirus)

· NL63 (alpha coronavirus)

· OC43 (beta coronavirus)

· HKU1 (beta coronavirus)

· MERS-CoV

· SARS-CoV

· SARS-CoV-2

The 229E and OC43 are most commonly associated with common seasonal flu.

The last three coronavirus strains on this list are less common. MERS-CoV causes Middle East Respiratory Syndrome (MERS). SARS-CoV is the cause of the Severe Acute Respiratory Syndrome or SARS, a disease that has caused an epidemic with a significant death toll back in 2003.

SARS-CoV-2 is the cause of COVID-19, a potentially fatal disease. It is a new strain of coronavirus that was most likely transmitted from animals to humans through the consumption of meat and other animal products. In late 2019 the virus started spreading among humans, first in China and then all over the world. Currently, there is no cure or vaccine available to treat this virus, but various antivirals are being studied and used on a trial by error method to reduce symptoms and comorbidities. The plasma of those who have already been infected with the corona virus and have antibodies against it is being considered as a treatment option as well.

Now, let’s talk about the new epidemic in more detail. We will take a closer look at the causes of the epidemic, transmission, risk factors, diagnosis, symptoms, treatment options, as well as travel and safety tips.

Causes

What we know so far is that the epicenter of the epidemic is in the Chinese province of Hubei. The first cases were reported at the end of 2019 and the speed in which the virus spreads is similar to the seasonal flu.

According to everything that we are seeing so far, the new coronavirus type (SARS-CoV-2) is also spreading in a way similar to seasonal flu. This means by close physical contact with infected individuals and most probably through respiratory droplets (coughing, sneezing, etc.).

When we say that this is a new virus, it only means that it is new among humans. It is very likely that this virus strain has already circulated among animals.

Scientists can track the Most Recent Common Ancestor (MRCA) for all types of human coronavirus. This means that they can, with great precision, determine the animal species from which the human form of coronavirus diverged. They can even tell when it approximately happen.

For example, SARS-CoV, a virus responsible for the SARS epidemic in 2003, originated in flying, warm-blooded vertebrates, such as bats and birds.

That is why researchers believe that the consumption of eggs, meat, and animal product-based traditional Chinese medicines is the most probable reason for the transmission of coronavirus from animals to humans.

When new virus strains find a way to infect humans and to spread among the human population, it is not uncommon for them to be more aggressive.

In the case of this new coronavirus type, around 2-4% percent of the infected people develop a severe form of the disease (now called COVID-19) which is characterized by severe breathlessness, respiratory infection (with respiratory failure), pneumonia, septic shock, and often death.

The rapid spreading of the new virus type and the number of fatal outcomes raised the alarm and attracted the attention of the media and the scientific community.

COVID-19 has however killed more than 3000 people worldwide out of more than 80.000 infected individuals. For comparison, the SARS epidemic in 2003 claimed 774 lives out of around 8000 infected people.

These numbers show us that this time we are dealing with a potentially more contagious, but less deadly disease. The number of infected individuals is much higher, but the percentage of fatal outcomes is significantly lower (around 3% compared to almost 10% with SARS).

Transmission

Respiratory droplets act as primary vehicles for the virus among humans. These droplets are exhaled, coughed up, and sneezed out.

They can transport the infection directly or by falling on surfaces that are commonly touched by other people. These include desks, tables, doorknobs, telephones, computers, bus and train handlebars, etc.

It is important to understand that respiratory droplets are suspended in the air only briefly. However, when they fall on glass, metal, or plastic surfaces they can remain contagious up to nine days, at room temperature.

This is why it is important to disinfect the surfaces with ethanol (60 to 70%), keep the hands clean and avoid touching your eyes, nose, and mouth. The same precaution methods that apply for the common flu (influenza) virus.

Other preventive methods include:

· Covering the mouth and nose when you cough and sneeze

· Avoiding contact with anyone who has symptoms of a respiratory infection

· Not sharing household items and bedding

· Staying at home if you are sick (according to the World Health Organization (WHO), one infected person is likely to infect two to four other people)

World Health Organization (WHO) does not recommend healthy individuals to wear a facemask. However, they do recommend to avoid the consumption of raw meat and other raw animal products.

Risk Factors

Certain actions, situations, and other factors can put an individual at a higher risk of becoming infected by the new coronavirus type. However, the infection itself does not mean that the symptoms of the diseases will be severe or life-threatening. That is why we can divide these risk factors into two groups:

1. Higher risk of infection

2. Higher risk of complications related to the infection

Those who are more likely to get infected by the SARS-CoV-2 are:

· Residents of China (especially the Hubei province and the city of Wuhan)

· People who have recently traveled to or from China, Iran, Italy, Thailand, Japan, South Korea, or any country with high incidence rates

· Members of the medical staff which takes care of the infected patients

· Individuals who were in close contact with someone infected

Some situations increase the risk of infection. For example, using public transportation or spending a lot of time indoors together with other people in areas where the presence of the new coronavirus has been confirmed also increases the risk of infection.

Some groups are at a higher risk of experiencing complications due to the coronavirus infection, these are:

· Pregnant women

· People older than 65

· Individuals with a weakened immune system (due to some pre-existing condition or medical therapy)

· Hospital patients

Symptoms

The infection with the new coronavirus type does not have the same clinical picture in all infected patients. This means that the symptoms of the infection can vary significantly. Some individuals can even be asymptomatic with no visible symptoms.

In most patients, however, the symptoms range from very mild and similar to a common cold, to extremely severe such as complete respiratory failure and death.

Much like the seasonal flu, the coronavirus infection starts with upper respiratory symptoms such as sneezing, runny nose, and sore throat. Fever is also common. In a majority of cases, further complications do not follow.

The following is a list of all the potential symptoms of a coronavirus infection:

· Sneezing

· Cough

· Runny nose

· Nasal congestion

· Sore throat

· Fatigue

· Fever

· Diarrhea

· Shortness of breath

· Pneumonia

· Septic shock

· Multi-organ failure

The incubation period after the initial infection can last anywhere between one and fourteen days, but two to four days are usually enough for the first symptoms to appear.

So far, the statistics show that around 80% of all those infected experience only mild symptoms and recover successfully. Further 14% of patients experience complications such as pneumonia and shortness of breath, but manage to recover with medical help.

Around 5% of infected individuals suffer from a severe manifestation of the disease that can include septic shock and organ failure. Death occurs in about 2% of all reported cases.

Diagnosis

Respiratory symptoms, like the ones described above, are more than enough to raise suspicion. Especially if you live in the affected territory or belong to any of the high-risk factor groups.

However, the coronavirus infection can only be proven by testing. Scientists acted quickly to isolate the new strain of the coronavirus, which is responsible for the epidemic.

They made their findings public so that the laboratories worldwide would be able to independently develop Polymerase Chain Reaction (PCR) tests. These tests are used to identify the virus in respiratory samples.

The results of PCR testing are available within hours or days. There are also nucleic acid tests and ELISA test kits available, which also provide results in a much shorter time compared to a classic blood test.

Health administrations in countries worldwide are considering the expansion of home testing for the new coronavirus. With the use of home testing, those who are suspected to be infected could provide samples for analysis without going to the hospital and increasing the risk of infection for others.

Treatment

The infection itself, or the cause of the disease, cannot be cured by any medications. However there are antiviral drugs that can help reduce symptoms and duration.

Supportive therapy can, but does not have to, include:

· Antipyretics for fever

· Analgesics for pain (e.g. headache, throat ache, etc.)

· Antitussives for cough

· Antihistamines for nasal congestion and sneezing

For patients with a more severe manifestation of the disease, like respiratory infections, there are more detailed treatment recommendations published by the World Health Organization (WHO) and the Chinese National Health Commission.

The WHO also advises against the use of immunosuppressants and steroids unless there are life-threatening complications, such as Acute Respiratory Distress Syndrome (ARDS).

Remdesivir®

A new antiviral drug called Remdesivir®, which is being developed as a treatment for the Ebola virus, is showing promise in treating respiratory infections with viruses such as SARS-CoV-2.

World Health Organization officials say that Remdesivir® clinical trials are currently underway and that the novel medication might be approved for use within weeks.

Vaccine

It is highly likely that a vaccine against SARS-CoV-2 will soon be developed. Researchers all over the world are working on it. However, a vaccine is not a cure for already infected people. It can only be used as a preventive method and a way to boost the immune response of humans to this new virus strain.

Tamiflu

Tamiflu, which is an antiviral used to reduce symptoms in those with influenza, has been shown to improve symptoms in some patients with coronavirus, but more research is needed.

Psychological Effect

The role of the media is mostly positive because the public needs to be informed about the spread of the new epidemic and the steps being taken by the authorities to keep it under control. However, there are some negative psychological effects of this overwhelming media campaign.

Fear is the number one negative effect. Many people are not aware of all the crucial facts and they are scared that this new virus is extremely deadly. This affects their mental health by causing anxiety.

Travel restrictions is also a big factor, it is advised to avoid traveling to countries with a high number of cases, which is impacting work and social life of many.

Quarantine is another concern. Healthy individuals may have to spend up to 14 days in quarantine if they are have been in contact with infected persons.

What to have in your Coronavirus Home Kit?

In case of a larger outbreak of the coronavirus or if there is a need for you or your family to stay in quarantine, this is what experts recommend you should have in your home kit:

1.A 14-day supply of food

The recommended food items are dry foods, such as rice, beans, oats, and pasta. You should also keep easy-to-make canned foods, chocolate, and coffee.

If you or any of your family members are using prescription medications, make sure to have a 30-day supply.

6.First Aid Kit

7.Batteries

8.Communications devices and chargers

9.Books, Board Games, etc.

Travel Tips

Planning a trip can be a bit challenging these days. The WHO advises against traveling to China, Iran, Italy, Thailand, Japan, South Korea, or any country with high incidence rates. This advice makes sense, and you should probably avoid visiting this part of Asia now if that is possible.

What about the other parts of the world? The list of countries with reported coronavirus infection cases is growing every day. Italy, a European country extremely popular with tourists and far away from China became a new hot spot of cases.

The answer is simple. If you can, cancel your trip. If you are sick, cancel your trip. If that is for some reason impossible, prepare yourself the best you can for possible disruptions and make sure to wash your hands often.

Safety

Large gatherings of people, especially in closed spaces, should be avoided during the epidemic. For similar reasons, public spaces such as train stations, airports, museums, and theme parks are not the safest places too.

It is good to have a supply of food and water in the house. Also, carry an identification document, any prescription medications you might be using, and proof of health insurance with you.

If you decide to travel, take backup communication devices, water, food, medications, and financial tools with you.

The Final Word

The COVID-19 is a disease caused by a new strain of coronavirus (SARS-CoV-2) circulating among humans. Since its outbreak in China, at the end of 2019, it has infected more than 80.000 people worldwide and killed more than 3000. These numbers seem alarming even though, statistically, they match the epidemic potential of a common seasonal flu. Nevertheless, precaution is advised. Especially to those belonging to higher risk groups.